Yehoshua Shapira

Hypodontia in Children with Various Types of Clefts

The prevalence of hypodontia in children with clefts, both inside and outside the cleft region, and the possible association between the side of the cleft and the side of the missing teeth were studied using radiographs of 278 patients with cleft lip, cleft palate, or both (158 boys and 120 girls), age 5 to 18 years (mean age 10.4 years). A hypodontia prevalence of 77% (excluding third molars) was found for the total cleft sample. This was significantly higher, both statistically and clinically, than the incidence of hypodontia reported for noncleft populations, and considerably higher than the prevalence reported in other studies of children with clefts. The maxillary permanent lateral incisors were the teeth most frequently missing on the cleft side (259 teeth) followed by the maxillary (47 teeth) and mandibular (23 teeth) second premolars, in both boys and girls. The teeth that were most often missing on the noncleft side were the maxillary second premolars (12 teeth), followed by the maxillary lateral incisors (10 teeth) and mandibular second premolars (6 teeth). Hypodontia of both the maxillary lateral incisors and second premolars was found more frequently on the left side, which also has a higher frequency of clefting.

Tooth transpositions — a review of the literature and treatment considerations

This paper defines tooth transposition and discusses its history, incidence and possible etiology. An interesting parallel is drawn between tooth transposition and other dental anomalies (number, size, shape and location of teeth). Treatment options are discussed in terms of the age at which the transposition is discovered, as well as in terms of severity and completeness of the anomaly. While a logical and relatively predictable treatment solution should normally be considered, in some selected cases it may be prudent to venture into more complex treatment solutions.

Congenitally missing second premolars in cleft lip and cleft palate children

Panoramic and periapical radiographs of 278 patients with cleft lip, cleft palate, or both (158 males and 120 females), age 5 to 18 years, were examined to determine the frequency of missing second premolars and the possible association between the cleft side and the side from which the premolar was absent. The prevalence (18%) of missing premolars found in this study is significantly higher than is found in the general population. A considerably higher incidence of missing second premolars was found in the maxilla compared with the mandible both for unilateral and bilateral missing teeth. The second premolar was absent more frequently on the left than on the right side, both in males and females and in both jaws. Interestingly but consistent with our previous reporting, this corresponded to the side where clefts occurred more often. The cause of the higher prevalence of left-sided clefts and missing second premolars in human beings is not known at the present time.

The distribution of clefts of the primary and secondary palates by sex, type, and location

The frequency and patterns of distribution of cleft lip, cleft lip and alveolus, cleft lip and palate, and isolated cleft palate, together with the possible association between sex, type of cleft, and affected side were studied from records of 278 individuals with clefts. These records were obtained from four cleft centers in the New York City area and constituted a racially mixed urban sample. The type of the cleft varied between sexes. Males had significantly higher rates of cleft lip and palate (p<0.0001), and females had higher rates of isolated cleft palate (p<0.0001). No sex differences were found for cleft lip or cleft lip and alveolus. Unilateral clefts of both the primary and secondary palates were found to occur over three times more frequently than bilateral clefts, and left side predominance was demonstrated.

Intrabony Migration of Impacted Teeth

Intrabony migration of impacted teeth is a rare dental anomaly, which occurs only in the permanent dentition of the lower jaw. The teeth involved in this phenomenon are the mandibular lateral incisor, canine, and second premolar. Migration of the lateral incisor is usually in a distal direction, resulting in transposition with the canine. Migration of the canine is most frequently in a mesial direction, resulting in transmigration across the mandibular symphysis to the opposite side of the dental arch. The second premolar most often migrates distally, sometimes past the gonial angle and as far as the coronoid process. Surgical and orthodontic treatment options are presented for the three intrabony migrating teeth.

Uprighting mesially impacted mandibular permanent second molars

Impaction of permanent teeth is a relatively common occurrence and can involve any tooth in the dental arch. Impacted mandibular second molars are relatively rare, but when they occur they may present a clinical problem for the orthodontist and oral surgeon. A typical case of bilaterally impacted mandibular second molars is illustrated, with orthodontic and surgical treatment options presented. Emphasis is placed on early diagnosis and initiation of corrective orthodontic therapy.

Maxillary canine-lateral incisor transposition—Orthodontic management

A case of maxillary canine-lateral incisor complete transposition is presented. Treatment options for transposed teeth, including alignment in their transposed positions, extraction of one or both transposed teeth, and orthodontic alignment to their normal positions in the arch, are discussed. The orthodontic technique and sequence used in this challenging case to align the fully transposed teeth to their normal position in the dental arch are described.

Povidone-iodine related burns.

Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in patients placed in the lithotomic position undergoing gynaecologic or urologic operations, the burn being on the buttocks, and in those undergoing orthopaedic operations, the burn being on the extremities and under a tourniquet. The basic mechanism involves irritation coupled with maceration and pressure. If the betadine solution has not been allowed to dry and has been trapped under the body of the patient in a pooled dependent position, such as the buttocks or under a tourniquet, the solution may irritate the skin and result in a skin burn. The irritation coupled with pressure leads to a situation analogous to that seen in the development of an acute accelerated decubitus ulcer; irritation, maceration, friction and pressure compounding each other to result in a skin burn or superficial ulcer in the skin. Our experience with three illustrative patients who presented with various burns following exposure to povidone-iodine (betadine) is described below.

Orthodontic management of mandibular canine-incisor transposition

This article presents five cases of an unusual dental anomaly--transposition of mandibular canine and lateral incisor. While every one of the presented cases had its individual characteristics, there are certain common traits. For instance, deciduous canines are usually retained, and the anomaly is found concurrent with other dental problems, such as congenital absence of teeth or peg-shaped lateral incisors. Many transposition cases also have a severe arch length discrepancy, which in itself may be an etiologic factor. In two of our cases orthodontic management included extraction of the transposed lateral incisor, whereas in the remaining three cases teeth were left in their transposed positions. On the basis of the longitudinal records of one of our cases, we speculate that there are early signs of transposition in the making, signs which should be recognized and which could possibly make transposition preventable.

Treatment of Impacted Cuspids: The Hazard Lasso

Abstract A clinical report illustrating hazards of the long-used lasso technique that is now being replaced by bonding and other less invasive methods for accelerating and guiding the eruption of impacted cuspids.